Obamacare Insurance Exchanges May Cover Diapers

Researching and preparing for my transition away from my godawful HMO, I've become a bit of an expert on Obamacare/ACA, also known as the Affordable Care Act. I'm one of the millions stuck with a godawful HMO, and crap access to care because of pre-existing conditions.

The Health Insurance Exchanges, which you are legally required to buy insurance from, unless you are Medicaid/Medicare eligible, or have qualified coverage from your employer, have some goodies we're just finding out about.

One of which is DME's, or Durable Medical Equipment, is considered essential coverage. In other words, insurance providers must cover DME's starting January 1, 2014, for most Americans.

One common DME is diapers.

The ACA doesn't set a lot of ground rules for what is a qualifying DME. That appears to be left up to HHS and the exchanges. It doesn't look like HHS has made a ruling on what is essential.

In Medicaid, covered DMEs include diapers. In Medicare, covered DMEs typically do not. It's a toss-up what Obamacare will fall under. Also state exchanges may be able to override HHS, at least in adding diapers if HHS blocks them.

Obviously, for incontinent people, this is a big win if diapers are included in the mandated DMEs. It's also a win for ABDLs. We're going to get much better diapers in America, in-line with Europe. The cost and quality of diapers will rise in order to bill insurance providers.

Then there's the debate for ABDLs as to if we should go and get prescriptions for diapers. While that is often criticized... I tend to believe if a diaper provides adequate psychological support, it's far better than most of the medications out there to relieve stress, anxiety, and even chronic pain. It may be a difficult conversation to have with your doctor/therapist, but free Secure Care X-Pluses and/or Abri-form X-Plus... may take some of the sting out of that conversation.

Still, don't get your hopes up yet too much folks. A lot of lobbyists in the diaper industry and insurance industry are probably pounding on HHS's door over this already. I have no idea which way this one will tip. There's so much not-yet-ruled on by HHS, we may not even know Jan 1 if diapers are a covered DME (but I suspect we'll have a good idea or a preliminary list by then).

Oh, and if you become eligible under the Medicaid expansion, also set to start Jan 1, 2014 - covered diapers are guaranteed. Check with your state to see if you are going to be covered under Medicaid.

(Please don't let this thread devolve into a debate about Obamacare... I'm checking my opinion at the door, I'll ask everyone else to do the same - bottom line it takes effect mostly on Jan 1 2014, and nothing really is going to stop it at this point from taking effect).

I've never had an insurance company cover my issues. Hell, most of my life I've never had insurance at all because my mother was a nurse and we got our stuff under the table.

I'm not a fan of insurance companies any more than the next guy, in fact, I think their entire business is a scam. But if we're to have to deal with them, here's hoping that they're at least useful to me and others.

Just trying to lay out options, there are several threads on this forum for pointing out the pros and cons with Obamacare as a model.

If you're going to be compelled to purchase health insurance, and diapers are a positive influence on your health care, this is certainly something to keep an eye on.

Though, I will say that each insurance exchange will handle DMEs differently if HHS approves diapers. Odds are some will let you buy your own diapers with a doctor's recommendation/prescription, and then be reimbursed. That logistic will likely be deferred to your specific state's insurance exchange (or the federal exchange if your state rejects its own exchange). Edit: Even then, individual insurers will have different choices... research carefully, an insurer could cover diapers even if HHS says it's not necessary... unlikely, but worth making a couple calls over when the exchanges open up.

Still, all of that is way too soon to get into. The big question right now is if HHS will rule that ACA's DME coverage compels diapers to be a mandatory-coverage item. But yes, bottom line, you may be able to buy your own and request a reimbursement from your insurer. We'll know more if HHS includes it in DME guidance.

I've always had health insurance, and I've used it several times. The first was for acute appendicitis. The second was for a bleeding ulcer that almost killed me. The third was for back surgery in which a tumor was growing on the nerves in my spine. The first two would have killed me without hospital intervention, and the third would have left me paralyzed from the waist down. Everyone should have a good hospitalization plan. Yes, they are expensive, but that's why we work our butts off. Somehow, diapers seem trite unless you are incontinent.

Medicare may not cover diapers but they would be a tax write off if needed. the big reason for Medicare not wanting to cover diapers is that there were a lot of crooks out there billing for diapers for seniors that never needed them or or never wanted the brands sent to them.(medicare fraud)

To have your diapers paid, you'd need a prescription. And prescriptions are not aquired easely. A Dr will never prescrive diaper to an open DL or AB.

This new change in public medical insurance will greatly help america IMO. In Canada, we have this already. Sure it's expensive, but healty citizens are more productive and make more money (pay more taxes).

And prescriptions are not aquired easely. A Dr will never prescrive diaper to an open DL or AB.

That I am not so sure. First, it is quite easy to get a prescription for diapers. Many doctors don't ask for testing, because testing for incontinence is so difficult to reliably diagnose.

Infantilism is a psychological condition in the DSM-IV, for which there is no cure. I'm not complaining about having it, but it is a mental disorder.

If most/all states declare diapers a DME, two things are going to happen:

1) Diapers are going to greatly improve in quality.
2) The retail cost of diapers here will soar. Especially if ACA changes Medicare to covering diapers too. HHS has yet to decide.

I think some sex therapists may prescribe diapers, faced with the fact that their patients are compelled to buy healthcare, and faced with the cost of diapers skyrocketing as they become a DME.

ACA will make some people's conditions worse, to get better. You're going to see 300 pound people gain weight to qualify for bariatric surgery. And, I think you'll see some ABDLs go incontinent to qualify for diapers. If Attends starts to cost $40/bag, which could happen, think what Abena will charge for their diapers, seeing insurance companies as their new primary customers.

My hope is that I'm earning enough so that it isn't a factor in my decision-making, but if push comes to shove, I will ask for the script one way or another.

I don't think they will cover Bambino's.

Of course, not today. But just wait. I could see Bianco's getting certified as a DME if this goes through. Actually, I think Secure Plus will probably take the Bianco design and put it into their own brand if this goes through.

That I am not so sure. First, it is quite easy to get a prescription for diapers. Many doctors don't ask for testing, because testing for incontinence is so difficult to reliably diagnose.

I've moved around frequently in the last two years and as such, I've had a number of doctors and a number of physicals. I always indicate incontinence on my paperwork for a new doc- I figure if I ever have a medical issue related to the fact I like to use diapers, it's good to let my doctor know I'm wearing them in advance. Conversation always goes as follows:

Doc: So... incontinence? Can you tell me about that?
Me: I had occasional nighttime and daytime wetting as a child. My pediatrician told me I'd grow out of it. I never did.
Doc: Alright. Would you like to see a specialist about that?
Me: No, that's alright. I manage it adequately with adult diapers and I'm satisfied doing so.
Doc: Ok, great. Now you indicated here that you handle hazardous materials...

I say it, it's accepted, and "urinary incontinence" goes into my record. Then we move onto the next item.

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Originally Posted by bob111

This new change in public medical insurance will greatly help america IMO. In Canada, we have this already. Sure it's expensive, but healty citizens are more productive and make more money (pay more taxes).